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Decolonizing "Mental Health": Defining the Term for Ourselves

By Marissa Tolero

FRI JUL 17, 2020

As a psychotherapist, "mental health" is a term I hear and use often: I use it to describe the work I do, I hear it from clients and colleagues multiple times a day, it's even in my official, credentialed title in the State of New York ("Licensed Mental Health Counselor"). I first heard the phrase in college when I began studying psychology. So for the last 13 years I've heard and talked about mental health pretty much daily. In a lot of ways, it has become part of my identity: working to improve and manage my own mental health while supporting others in the same journey.

Photo by Polina Zimmerman
Photo by Polina Zimmerman

I didn't think to question or interrogate mental health until the most recent months amidst national and global conversations about decolonizing from white supremacy after George Floyd's murder. I looked at what I do, think, and feel and considered how all aspects of my being might be influenced and/or a direct result of white supremacy. I finally understood that just as important as the personal work of decolonizing myself is, so is decolonizing the professional work I do of yoga and therapy. The prospect of this felt overwhelming. Where do I start in decolonizing yoga and therapy? Reading "Decolonizing Trauma Work: Indigenous Stories and Strategies" by Renee Linklater directed me to a place to start, which is where she starts in the book: with the very definition and terminology of "mental health."

The modern usage of "mental health" derives from the term "mental hygiene," which is still referenced in some contexts today. "Mental hygiene" was coined in the late 1800's after the Civil War when concern increased over unsanitary conditions. A doctor who co-founded the American Psychiatric Association defined it as "the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements" (John Hopkins University). Fast forward to 1946, when the first Mental Health Association was founded in London and created the technical reference of mental health as a field or discipline (World Psychiatry). Going forward, mental health was clinicalized and medicalized. In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) in 2013 - the text currently used by psychotherapists, psychologists, and psychiatrists to diagnose mental disorders in the U.S. - there is no actual definition for "mental health." Just "mental disorder," which is discussed and referred to throughout as the antonym of mental health.

The very usage of the word "health" in "mental health" provides a context of health vs. illness, which is why we often understand mental health as the absence of mental illness/disorder. It wasn't until the last few decades in which the wellness movement has gained mainstream momentum that many expanded the definition to include a perspective of wholeness: mental health as mental, emotional, and even spiritual well-being. While this shows great progress in the social understanding of mental health and individual clinician's approaches to their work, the actual mental health system still views it from the medical perspective. This is mostly seen in the necessity of one to be "diagnosed" with a mental "disorder" from the DSM-5 in order to receive insurance coverage for services they may be receiving from a professional.

Photo by cottonbro
Photo by cottonbro

By requiring the healthcare system to view mental health in this way, anyone who wants to receive and get reimbursed for services is required to abide by this perspective. This is a form of systemic white supremacy at play: white men created the term "mental health," defined what it means by choosing what does and doesn't qualify as a "disorder", and then built a system to support and perpetuate that definition. This leaves little room for people of color to have their worldviews of mental and emotional experiences, as well as their healing strategies, validated and recognized. And while the DSM-5 has a section at the end of the text called "Cultural Formation" that provides a guideline for clinicians to understand individual and cultural perspectives of "illness experience," it is still relegated to the end as a side note and discusses these cultural perspectives as alternative/other/different. This implies that the white, Eurocentric perspective is default and normal.

To provide a concrete example, Linklater writes the following about Indigenous trauma and Western psychology/mental health vs. Indigenous wellness and healing:

"Indigenous trauma has been largely 'diagnosed' through non-indigenous theories. Western frameworks of psychiatry and psychology have medicalized the experiences of Indigenous peoples, applying diagnoses such as post-traumatic stress disorder, further pathologizing their trauma...Bringing "psychology" and "mental health" into an Indigenous framework is often confusing and misleading. Indigenous concepts of wellness and Western psychology greatly differ in ways of conceptualizing the person and in determining a healing process. Wellness philosophies are wholistic approaches that consider equally the spiritual, emotional, mental and physical aspects of the person, whereas Western psychology generally focuses on the mind and behavior, and Western medicine treats the mind and body as separate entities...Indigenous healing philosophies are based on a wellness model, while the medical model is based on illness...an Indigenous paradigm of mental health and healing is 'focused on restoring balance to the self through relationship with others and the environment.'" (pgs 20-21, Linklater, 2014).

Photo from fernwoodpublishing.ca
Photo from fernwoodpublishing.ca

So, how do therapists, therapy-goers, and anyone else interested in their well-being decolonize from the Eurocentric notion of mental health? We start by defining our own meaning. We do this by looking at our own cultures' perspective of mental, emotional, and wellness experience. We can ask questions such as: Is there a different term used in my culture? What does it mean? How are people conceptualized and understood in my culture? What healing and growth strategies are used to respond to mental, emotional, spiritual, etc. challenges?

Once you have answers to those questions, you decide for yourself how you want to understand "mental health." Perhaps you resonate with the Western philosophy, perhaps there are aspects of it that you can carry into your own perspective. Whether you continue to use the term "mental health" is up to you, all of it is up to you. However, we must always keep in mind that the dominant message of what mental health is and how to treat it has been taught to us by systematic white supremacy and for ourselves and others, it is of utmost importance to undo that and come to our own definitions and meanings whether we decide to continue using the term or find another one that aligns with us better.

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This blog post is not intended to take away from the seriousness that is mental heath, but to consider where the term and its medicalized meaning comes from. It is also not intended to take away from any benefit or empowerment one has received through the U.S. mental health system as so many have been helped by this model (including myself, both as a therapy-goer and as therapist), but again, to consider it's history and that it's not the only way to understand mental health (or whatever term we choose to describe it).

You can see a little into the personal and professional work I am doing. While I do this, I continue to offer yoga+therapy, which I am actively unlearning and relearning from a decolonized approach. I invite anyone who wants to work with me to join me on this journey in our sessions together and in your life. If any of this resonates with you and you are interested in working with me one-on-one (whether to decolonize yourself or for support in any other life challenges), then schedule a complimentary consultation for virtual yoga+therapy for women and LGBTQ+ to learn how I can support you.

Namaste and Love,

Marissa